AAACEUs Blog

The NOTICE Act and MOON: A year in, what's the implication?

By AAACEUs

In this month's article we discuss the Notice of Observation
Treatment and Implication for Eligibility Act that was adopted in August, 2016.
We hear from many professionals impacted by the NOTICE Act that adoption of the
new rules and process has come with the standard set of growing pains and
additional controversies. In this article, we'll discuss some of the most
common controversies and points of confusion for both patients and professionals
alike.

The Notice of Observation Treatment and Implication for Care
Eligibility Act (NOTICE Act) was adopted in August, 2016. The NOTICE Act
established a standardized method of informing patients of their admission
status. On March 8th, 2017, hospitals began issuing a form, Medicare Outpatient
Observation Notice (MOON), to their patients.

This was a significant change, as previously patients were told
upon admission if their status was observation or inpatient. Few patients
understood the implication of that status. Each facility had their own process
and procedure for informing patients and, in addition, their own timetable.
There was little uniformity throughout the industry. Patients given verbal
notice complained of not understanding their status and, specifically, the
financial implications. The MOON form was in response to this scenario and was
adopted in attempt to address patient confusion.

As we approach a year since the MOON form was adopted, certain
challenges and controversies have been raised.

One concern brought forward by The Center for Medicare Advocacy,
a national non-profit advocacy group focused on Medicare-related issues, was
that the rule does not require hospitals to explain the MOON form or provide
the specific reason the patient is being considered an outpatient. This
decision is different than most Medicare notices.

The most challenging section to be completed on the MOON form is
the following:

"You're a hospital outpatient receiving observation
services. You are not an inpatient because:
_____________________________."

When looking at the Medicare Benefit Policy Manual, observation
care is "a
well-defined set of specific, clinically appropriate services, which include
ongoing short term treatment, assessment, and reassessment before a decision
can be made regarding whether patients will require further treatment as
hospital inpatients or if they are able to be discharged from the
hospital."

In light of that guidance, a common answer will frequently be
something along the lines of "you
require ongoing short term treatment or assessment before a decision can be
made whether you will require treatment as a hospital inpatient."
This response often leads to patient confusion.

Another aspect of the MOON form creating controversy is the lack
of a process of appeal. Most Medicare notices of coverage determination will
provide the beneficiaries an opportunity to appeal to Medicare. Only the MOON
form defines the coverage issue as non-appealable. Just as beneficiaries can
challenge a premature discharge or contest a host of other coverage
determinations in the Medicare program, it is felt that they should be able to
appeal their placement on Observation Status.

The
main goal of the NOTICE Act and use of the MOON form was to assist in the
process of observation admission and to make the patients aware of their
responsibilities and the consequences of their admission status. After nearly a
year of adapting the new process, the picture remains confusing for both
providers and patients alike. Watch this space for updates to the process as
these issues and concerns are addressed.